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Costs of care for pneumonia in nursing home residents vary widely and could be reduced

Pneumonia is a leading cause of hospitalization and death among nursing home residents, and the usual hospital cost for treating an episode of pneumonia exceeds $7,000. However, many nursing home residents are treated for pneumonia in the nursing home, where the average cost for treating an episode is $458, according to a study supported in part by the Agency for Healthcare Research and Quality (HS08551).

Residents whose pneumonia is treated in the nursing home benefit by avoiding the stress of relocation, complications, and increased functional dependence associated with hospitalization. However, their care requires more time from staff, who may already be fully occupied, and certain treatments are only available in the hospital, explains David R. Mehr, M.D., M.S., of the University of Missouri-Columbia.

As part of a larger study of lower respiratory infection in nursing home residents, Dr. Mehr and his colleagues examined the costs of pneumonia care for 502 people with pneumonia who were residents of 36 Missouri nursing homes and were not hospitalized. The study included residents evaluated in the ER and returned to the nursing home without being admitted to the hospital. X-rays accounted for almost half of the average cost of $458 for treating an episode of pneumonia in the nursing home, most likely because of the higher cost of mobile x-rays. Provider evaluations and medications each accounted for about 20 percent of the costs.

Medication costs varied the most, ranging from $.04 to over $700 for residents who received any medication. Episode costs were higher for residents seen in a hospital ER, residents with decubitus ulcers, black residents, and residents in larger facilities. Sending only the sickest residents to the ER for evaluation and avoiding use of the most expensive antibiotics are two of the most likely ways to reduce costs, suggest the researchers. However, they caution that the effects of cost reductions on outcomes are unknown, and cost reduction should not be at the expense of appropriate care.

More details are in "The cost of treating pneumonia in the nursing home setting," by Robin L. Kruse, Ph.D., Keith E. Boles, Ph.D., Dr. Mehr, and others, in the March/April 2003 Journal of the American Medical Directors Association 4, pp. 81-89.

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